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SubscribeWhen you have heart disease, becoming pregnant can feel worrisome, if not dangerous or impossible. For some women, their heart risk may seem so great that they’ve long ago put aside the idea of trying to conceive.
Fortunately, we continue to learn a lot about heart disease and pregnancy. Cardio-obstetrics is a growing field and, as with many areas of medicine, we’ve seen an exponential increase in our research and knowledge. Today, we have much more information to help us determine the risk of pregnancies with various heart conditions and what steps we can take to make them as safe as possible.
As a cardiologist, I specialize in adult congenital heart disease and cardio-obstetrics (the care of pregnant women with heart disease) and have helped many women care for their hearts while carrying and delivering healthy babies. I know how life-changing it is for a woman with heart disease to conceive and deliver a baby she never thought possible.
I also know how important it is that she do this with the help of a dedicated multidisciplinary care team.
The number of pregnancy-related deaths in the United States has more than doubled over the last two decades, according to the American Heart Association; the main cause is cardiovascular disease. The most common cardiovascular issues we see are hypertensive disorders of pregnancy, including preeclampsia, gestational hypertension (high blood pressure) and chronic hypertension, but we also care for many women with congenital heart disease, heart failure and abnormal heart rhythms.
It’s crucial that we approach pregnancies with these and other heart conditions in a careful, deliberate and thoughtful manner.
If you’re a woman with congenital heart disease or a heart condition, here are some key points you’ll want to consider if you’re thinking about becoming pregnant — or find that you already are.
Obviously, this isn’t something you can do if you’re already pregnant, but if you have any question about how your heart may handle pregnancy — or whether conceiving is safe for you — then pre-pregnancy counseling is essential.
You’ll feel best about your decision when you’re most informed. Your cardio-obstetric team — which could include obstetricians, cardiologists, anesthesiologists, maternal fetal medicine specialists, geneticists, nurses and pharmacists — will weigh all of the factors alongside your possible pregnancy, delivery and postnatal care, and provide your individual risk estimate.
We let patients know that no matter what decision they make, their care team will be there to help them through it. We’re always weighing what’s best for you and your baby and trying to maximize the outcome for both.
You may be surprised to discover you have heart disease you didn’t know about. Even women who have had successful pregnancies may find that their risks have increased as they’ve gotten older.
Time can result in changes to chronic heart conditions, or you may have developed a new heart condition. This isn’t necessarily cause for alarm, but you’ll still need to work with health care professionals to determine your risks before or during your pregnancy.
If you have heart disease and find yourself pregnant, or if you’re pregnant and discover you have heart disease, you’ll want to meet with a care team as soon as possible to determine your course of care. These measures are also discussed during pre-pregnancy counseling.
If you have heart disease and a high-risk pregnancy, it’s important that you monitor how you’re feeling during and after your pregnancy and call your doctor if you experience any sudden changes. From a heart standpoint, symptoms of concern could include palpitations, chest pain, difficulty breathing or increasing shortness of breath. Being aware of your body and communicating changes to your medical providers should be a critical part of your care plan.
Above all, make sure you work closely with your cardio-obstetrics team, and don’t be afraid to share information and ask questions. The more we know ahead of time, the better we can prevent and prepare for complications to help get you and your baby safely through your pregnancy.
The Center for Women's Health provides personalized care for women across their lifespans.
Expert care starts here